| NPI | 1013412998 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: MA 286808) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL TRN26406) |
| Enumeration Date | 2018-03-24 |
| Last Update Date | 2023-01-24 |